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L..1 1 —J <br /> Fax co8- of Lab Report and COC to Chevron Co t• ❑ No Cha 7of—CuSf —Record <br /> Chavnon Foalllty Humber 9-8632 Chevron Contact (Nome) BreCC Iluncer <br /> 6Facility Address 579 Grantline Rd. , Tracy, <br /> � ( (Phony)CA (51.0) 842-8695 <br /> Yt0>Z U.S.A..S.A., Inc. r7`Cr <br /> P 0 BOX 5004 Consultant Project Number. f Sy ? - Loborutory Name Se uoid <br /> Consultant Name Blaine Tech Services, Inc. 2642861 <br /> Son Ramon, CA94563 t Laboratory Release Number <br /> TLmuLlty Dr , San .fo5c , CA 951 1a <br /> FAX (415)$42-9591 Addrou X85 -- Snmptes Collected by (Hams) <br /> Project Contact (Name) Jim Kelle1' Colleotlon Dale 5 <br /> (Phan-ADLAD -n -5—(Fos Number)IJQB-19--831 _ Slynoturs <br /> Analyess To Be Performed <br /> � o no NOT BILL <br /> C a <br /> _ ZU a Y 6 r 7 <br /> C. <br /> z c3 v� >t E o 'x .. FOR T8-LB <br /> VIS VVA aC }� + <br /> a AAA <br /> d n u., O o N aN <br /> E A )= 1 >t R a� a c <br /> ►X x' u13r r- I i'1� �'J o �i" ►i �i ►%i c'� �. Remarks <br /> 20 <br /> !/ /UJ <br /> BY k urs Organization Dots/Tlms Iteoelvod By (Slgnolure) Organization Dota/Time Turn Around ]Imo (Circle Choice) <br /> 24 11m. <br /> Rf ($1gn ur Organlzotlon Date/lime Recolvod Dy aturs) Orga 1 tlon Dots/Jlme 48 Hn. <br /> 1 'r b <br /> ---- 10 Uay■ <br /> nature) or ao tlon e• ma liecleved or Laboratory (Sl9gat a) Uatsrll s M Conlrao4sd <br />